WASHINGTON, DC — How does a diagnosis of pulmonary hypertension (PH) affect survival in patients with non-small cell lung cancer (NSCLC)?
That is the question addressed in a study from the VA and U.S. military research organizations.
“Lung cancer is one of the most lethal cancers, with survival being closely related to stage and influenced by comorbid illness. The survival implications of pulmonary hypertension (PH) on patients with have only been evaluated in small cohorts, with limited long-term follow-up,” write the authors from the DC VAMC, and the Uniformed Services University, the John P. Murtha Cancer Center Research program, the Henry M. Jackon Foundation for the Advancement of Military Medicine and Walter Reed National Military Medical Center, all in Bethesda, MD.
The study team conducted a retrospective cohort study of 7,946 patients with NSCLC diagnosed in the MHS, classifying patients as having and not having PH and taking into account if the diagnosis occurred before development of NSCLC. Results were published in the Journal of Clinical Medicine.1
Results indicate that, compared to patients without PH, patients with PH diagnosed before NSCLC had an increased risk of death (HR = 1.15 [95% CI, 1.02–1.29]). The researchers report that the increased risk of death was more obvious for patients with PH diagnosed after NSCLC compared with those without PH (HR = 2.74 [95% CI, 2.51–2.99]). “The results were similar when stratified by patient demographics,” they add.
The study concludes, “In the MHS, PH is associated with worsened NSCLC survival, regardless of when it is diagnosed. When PH is diagnosed after NSCLC, it is associated with a marked reduction in survival, and this finding may suggest a potential role for monitoring pulmonary pressures in NSCLC patients. Furthermore, as specific PH therapy exists, some NSCLC patients with PH may be candidates for therapy.”
Background information in the article notes that lung cancer, the second most common cancer in males and females, is also the most lethal, causing an estimated 22% of cancer deaths in the United States. It advises that stage at diagnosis remains the primary determinant of survival, although comorbid conditions have also been linked to survival.
“In many diseases affecting the human lung, pulmonary hypertension (PH) when present, portends a poor prognosis,” the researchers advise. “PH in patients with sarcoidosis, idiopathic pulmonary fibrosis, and COPD is associated with shortened survival. Little is known, however, about the impact of PH on the survival of patients with non-small cell lung cancer (NSCLC).”
A 2019 study found that the high prevalence of chronic cardiopulmonary conditions among VHA patients suggests that military veterans might be especially susceptible to PH. Using the VHA Corporate Data Warehouse to identify veterans diagnosed between Jan. 1, 2003, and Sept. 30, 2015, a study team from Emory University and the Atlanta VAMC found there were 110,564 veterans diagnosed with PH during the study period. The veterans were predominantly male, had a median age of 70.2, and had a high burden of comorbid conditions. “PH was frequently due to left heart and/or lung disease. Average survival after PH diagnosis was 3.88 years,” the authors added.2
The current study is the largest to date investigating the association between PH and long-term NSCLC outcomes. The authors note that their results “identified a clear association between a diagnosis of PH and reduced all-cause survival in patients with NSCLC. There appears to be a much stronger association between PH diagnosed after an NSCLC diagnosis and long-term survival, as opposed to the more modest apparent association between baseline PH and NSCLC survival.”
The researchers write that their findings aren’t unexpected but call for more studies on the matter. “While not a surprising finding,” they write, “further research is warranted to understand the mechanisms for the development of pulmonary hypertension in non-small cell lung cancer. Furthermore, this may provide a potential beneficial role for pulmonary hypertension screening in patients with non-small cell lung cancer and during follow-up after therapy. Lastly, pulmonary hypertension in patients with non-small cell lung cancer may provide a target for therapy.”
- Nations JA, Lin J, Park AB, Shriver CD, Zhu K. Pulmonary Hypertension and Survival among Non-Small Cell Lung Cancer Patients: A Retrospective Cohort Study in the U.S. Military Health System. J Clin Med. 2024 May 30;13(11):3217. doi: 10.3390/jcm13113217. PMID: 38892928; PMCID: PMC11173320.
- Trammell AW, Shah AJ, Phillips LS, Michael Hart C. Mortality in US veterans with pulmonary hypertension: a retrospective analysis of survival by subtype and baseline factors. Pulm Circ. 2019 Jan-Mar;9(1):2045894019825763. doi: 10.1177/2045894019825763. PMID: 30638433; PMCID: PMC6381440.